Çocuklarda Plevral Ampiyemde Video Yardımlı Torakoskopik Dekortikasyonun Sonuçları

Year 2023, Volume: 17 Issue: 6, 451 - 454, 27.11.2023

Ufuk Ateş , Ergun Ergün , Anar Qurbanov , Pari Khalilova , Sümeyye Sözduyar , Ergin Çiftçi , Halil Özdemir , Gül Arga , Hatice Kubra Konca , Emrah Gun , Tanıl Kendirli , Meltem Koloğlu , Aydın Yağmurlu , Ahmet Çakmak , Gülnur Göllü Bahadır

https://doi.org/10.12956/tchd.1294886

Abstract

Amaç: Bu çalışmanın amacı, çocukluk çağı ampiyeminde iki port tekniği ile video yardımlı torakoskopik cerrahinin (VATS) etkinlik, güvenlik
ve uygulanabilirliğini belirlemektir.

Gereç ve Yöntemler: Çalışmaya 17 yaş altı 34 hasta dahil edildi. Hastaların demografik ve klinik verileri geriye dönük olarak kaydedildi.

Bulgular: Çalışmaya 17 yaş altı 34 hasta dahil edildi. Şikayetlerin ilk başladığı gün 12 gündü. Hastaların şikayetleri başladıktan ortalama
12 (2-46) gün sonra VATS uygulandı. Ampiyem 21 çocukta sağ hemitoraksta, 11 çocukta sol taraftaydı. İki hastaya bilateral dekortikasyon
uygulandı. Drenaj için takılan göğüs tüpünün çıkarılma süresi ortalama 9.70 (2-26) gündü. Ameliyat sonrası kalış süresi 23.50 (4-120) gün
iken, toplam hastanede kalış süresi 32.50 (7-142) gündü. Takipler sırasında 7 hastada amfizem gelişti. Bir hastaya göğüs tüpü revizyonu
yapıldı. 6 hastada spontan geriledi. İki çocuk solunum arresti ve karaciğer nakli sonrası torakoskopi dışı nedenlerden exitus oldu.

Sonuç: VATS, çocuklarda plevral ampiyemde sonuçları iyi olan, uygulanabilir bir yöntemdir. Sonuçlar hastalığın erken veya geç döneminde
tatmin edicidir.

Keywords

Çocuk, Ampiyem, Cerrahi, Torakoskopik, VATS

Supporting Institution

yok

Thanks

yok

Outcomes of Video-Assisted Thoracoscopic Decortication in Pleural Empyema in Children

Abstract

Objectives: The aim of this study is to determine efficacy, safety, and feasibility of video-assisted thoracoscopic surgery (VATS) in childhood empyema with two port technique.

Materials and Methods: 34 patients under 17 years of age were included to the study. Demographic and clinical data of the patients were recorded retrospectively.

Results: 34 patients under 17 years of age were included in the study. The first time the complaints started was 12 days. VATS was performed on mean 12 (2-46) days after the complaints of the patients started. The empyemas were in right hemithorax in 21 children and left in 11. Two patients underwent bilateral decortication Mean of chest tube removal time was 9.70 (2-26) days. While the postoperative stay was 23.50 (4-120) days, the total hospital stay was 32.50 (7-142) days. Emphysema developed in 7 patients in the following period. Chest tube revision was performed in a patient. Emphysema spontaneously regressed at follow-up in 6 patients. Two children had died due to 1- arrest and 2 – after liver transplant.

Conclusion: VATS is a feasible method with good results pleural empyema in children. The results are satisfactory in the early or late period of disease.

Keywords

VATS, Children, Empyema, Surgery, Thoracoscopic

References

• Mohajerzadeh L, Lotfollahzadeh S, Vosoughi A, Harirforoosh I, Parsay S, Amirifar H, et al. Thoracotomy versus video-assisted thoracoscopy in pediatric empyema. Korean J Thorac Cardiovasc Surg 2019;52:125–30.
• Cremonesini D, Thomson AH. How should we manage empyema: Antibiotics alone, fibrinolytics, or primary video-assisted thoracoscopic surgery (VATS)? Semin Respir Crit Care Med 2007;28:322–32.
• Ahn HY, Cho JS, Kim YD, Hoseok I, Song S, Eom JS, et al. Factors Affecting Postoperative Lung Expansion in Patients with Pyogenic Empyema. Thorac Cardiovasc Surg 2018;66:697–700.
• Majeed FA, Chatha SS, Zafar U, Chatha UF, Chatha AZ, Farooq Z. Surgical management of paediatric empyema: Open thoracotomy versus video-assisted thoracic surgery. J Coll Physicians Surg Pakistan 2020;30:309–12.
• Subramaniam R, Joseph VT, Tan GM, Goh A, Chay OM. Experience with video-assisted thoracoscopic surgery the management of complicated pneumonia in children. J Pediatr Surg 2001;36:316–9.
• Barglik R, Grabowski A, Korlacki W, Pasierbek M, Modrzyk A. Pleural empyema in children – Benefits of primary thoracoscopic treatment. Wideochirurgia I Inne Tech Maloinwazyjne 2021;16:264–72.
• Pogorelić Z, Bjelanović D, Gudelj R, Jukić M, Petrić J, Furlan D. Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome. Thorac Cardiovasc Surg 2021;69:475–80.
• Tong BC, Hanna J, Toloza EM, Onaitis MW, D’Amico TA, Harpole DH, et al. Outcomes of Video-Assisted Thoracoscopic Decortication. Ann Thorac Surg [Internet] 2010;89:220–5.
• Velaiutham S, Pathmanathan S, Whitehead B, Kumar R. Video-assisted thoracoscopic surgery of childhood empyema: Early referral improves outcome. Pediatr Surg Int 2010;26:1031–5.
• Zhang Y, Xie Y, Luo Y, Xiang S, Zhong W, Wu N, et al. Massive secretions in paragonimiasis pleural effusion: a new finding concerning clinical recognition and treatment. Eur J Clin Microbiol Infect Dis 2023;42:493–501.
• Luh S-P, Chou M-C, Wang L-S, Chen J-Y, Tsai T-P. Video-Assisted Thoracoscopic Surgery in the Treatment of Complicated Parapneumonic Effusions or Empyemas. Chest [Internet] 2005;127:1427–32.
• Livingston MH, Colozza S, Vogt KN, Merritt N, Bütter A. Making the transition from video-assisted thoracoscopic surgery to chest tube with fibrinolytics for empyema in children: Any change in outcomes? Can J Surg 2016;59:167–71.
• St. Peter SD, Tsao K, Harrison C, Jackson MA, Spilde TL, Keckler SJ, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg [Internet] 2009;44:106–11.
• Lok S, Davies RJO. The systemic fibrinolytic activity of intra-pleural streptokinase in humans. Thorax 1996;51:328–30.
• Rodriguez JA, Hill CB, Loe WA, Kirsch DS, Liu DC. Video-assisted thoracoscopic surgery for children with stage II empyema. Am Surg 2000;66:569–72.
• Parelkar SV, Patil SH, Sanghvi BV, Gupta RK, Mhaskar SS, Shah RS, et al. Video-Assisted Thoracoscopic Surgery for Pediatric Empyema by Two-Port Technique: A Single-Center Experience with 167 Consecutive Cases. J Indian Assoc Pediatr Surg 2017;22:150-4.